“Of 56.4 million global deaths in 2015, 39.5 million, or 70%, were due to non-communicable diseases (NCDs). The four main NCDs are cardiovascular diseases, cancers, diabetes and chronic lung diseases. The burden of these diseases is rising disproportionately among lower income countries and populations.” This quote is taken from the website of the World Health Organization (WHO), specifically, its Data page on NCD mortality and morbidity, and it highlights the significant threat that so-called “lifestyle diseases” pose to “lower income countries and populations” like Guyana.
Two of the characteristics of NCDs, also called “chronic diseases,” are that they are usually of long duration and slow progression. This means that they exact a tremendous financial cost on the sufferers along with the physical and psychological burden. Chronic diseases are not generally preventable by vaccinations or curable by medication, and are usually caused by patterns of behaviour which are damaging to the health of the individual. Health damaging lifestyles include smoking, alcohol consumption, poor eating habits, and low physical activity or exercise. Thus, while being largely incurable, NCDs are highly preventable once persons can be encouraged to make and inculcate healthy lifestyle choices and habits.
In July this year, Dr Alafia Samuels, Director of the Chronic Disease Research Centre, at University of West Indies, Cave Hill Campus, pointed to the fact that Guyana and Trinidad and Tobago hold the dubious distinction of being ranked first and second, respectively, in deaths and overall prevalence of heart disease and diabetes. The lifestyle causes were listed as decreased physical activity, obesity, bad diets, tobacco smoking and alcohol abuse, and as Dr Samuels further illustrated, “Our grandparents grew their food. Our parents went to the market. We go to the supermarket and our children go to the fast food outlet.”
The impact of negative lifestyle choices on the health of the society is shown in the increasing levels of NCDs within the population. This in turn negatively impacts the income and welfare of each household affected by the NCD. According to the WHO, “Poverty is closely linked with NCDs, and the rapid rise in the magnitude of these health problems is therefore predicted to impede poverty reduction initiatives in low-income countries and communities.”
The Government of Guyana seems to recognise that this issue is an important one in both national health and national development contexts. In July 2016, the Ministry of Public Health’s Chronic Disease Unit was scheduled to conduct a STEPwise approach Population Based Survey, from July to October 2016 to determine the chronic disease risk factor and surveillance in Guyana. The STEPwise approach to data collection is designed by the WHO to use standardised questions and protocols to achieve results that are easily comparable across countries. The Guyana survey was supposed to cover 3,456 households across the country interviewing persons aged 18 to 69, and the Bureau of Statistics was expected to collaborate with the Ministry of Public Health in this regard.
Just this December, President David Granger agreed to chair a Commission on Non-Communi-cable Diseases, seeking “to up the ante” in the fight against lifestyle diseases (as reported by this newspaper). The President pointed to “cultural carelessness” as resulting in the situation where roughly “seven out of every ten deaths of Guyanese, aged 23-60 years, are caused by cancers, chronic lung diseases, diabetes, heart disease and hypertension.”
The President showed a personal awareness of the impact his office can have in the fight to achieve increased national awareness as a necessary component of the strategy against NCDs when he said, “That is why I have come here today to lend my name and my Office so that children everywhere, schools, adults, the drinking classes, the smoking classes will know that it is at the level of the President himself that attention will be paid to NCDs and the prevention of NCDs.”
In July 2017 the Guyana Parliament passed what was deemed a landmark piece of legislation, the Tobacco Control Bill of 2017, which aims to achieve a ban on smoking in public places and to end the sale of cigarettes to minors, fulfilling the requirements in the WHO Framework Convention of Tobacco Control ratified by Guyana government in 2005.
But indeed, while the passage of Tobacco Control legislation is a necessary cog in the wheel in the fight against NCDs, the strategy being employed so far seems to be focused mainly in the arena of information dispensation, and not quite so clearly on treatment. The President’s three-pronged strategy, according to the Ministry of the Presidency release, refers to a public information strategy on the dangers of negative lifestyle choices; it then references a strategy for a “promulgation of initiatives” to be led by the media, the entertainment industry and trade unions, and thirdly a strategy for “a comprehensive and multi-sectoral approach to implement prevention and control measures.”
Since the first two strategies seem to be in the area of information dissemination, we must conclude that the third relating to implementing “control measures” will be directed at those persons currently suffering from chronic diseases. In this single phrase there must be encapsulated the government’s strategy in relation to screening and early detection of NCDs, the provision of quality and affordable medical care, and the provision of adequate social or welfare remedies to affected households.
Influencing positive lifestyle changes is a key component of any strategy to combat NCDs, but delivering appropriate medical care, and seeking to prolong and enhance the productive life of the many Guyanese already suffering from chronic diseases must also be part of an aggressive strategy to combat and control “lifestyle diseases.”
The fight against NCDs is a national health emergency that continues to have a debilitating effect on our national development. The Commission must seek tangible results as it proceeds to “up the ante” in this fight.